Assessment of HPA-Axis Suppression with Fluticasone Cream 0.05% in Patients with Extensive Psoriasis or Eczema

Abstract

Objective: This study evaluated the effects of fluticasone cream 0.05% on the hypothalamopituitary-adrenal (HPA) axis in patients with extensive psoriasis or eczema.

Patients: Six inpatients in a hospital setting, three with extensive eczema and three with extensive psoriasis of at least 30% body surface involvement, were enrolled in this study.

Methods: In an open-label design, all patients received fluticasone cream 0.05%, 15g applied twice daily without occlusion for 7 consecutive days. The primary outcome measures were HPA-axis suppression (determined by morning plasma cortisol and 24-hour urinary free cortisol concentrations), selected blood chemistries, urinalysis and haematology profile.

Results: During the treatment phase, four of the six patients studied experienced insignificant changes in morning plasma cortisol concentrations. In one patient, a decrease in plasma cortisol concentrations occurred following several days of treatment; these concentrations recovered after 6 to 7 days of treatment. In the remaining patient, a marked decrease in morning plasma cortisol concentrations occurred, which may have been attributed to consumption of alcohol by this patient.

Conclusion: Fluticasone cream 0.05% was well tolerated in patients with extensive eczema or psoriasis and had a low potential for suppressing endogenous cortisol secretion, even when applied to extensive areas of diseased skin for 7 days.